Effectiveness of oseltamivir in adults: a meta-analysis of published and
unpublished clinical trials.
Author(s): Ebell MH(1), Call M, Shinholser J.
Affiliation(s): Author information:
(1)Department of Epidemiology and Biostatistics, College of Public Health,
University of Georgia, Athens, GA 30602, USA. ebell@uga.edu
Publication date & source: 2013, Fam Pract. , 30(2):125-33
BACKGROUND: Oseltamivir is widely used for the treatment of influenza. Previous
systematic reviews suggest that they reduce complications, but had significant
methodologic limitations.
OBJECTIVE: To assess the effect of oseltamivir on duration of symptoms,
complications and hospitalizations in adults.
METHODS: We searched Medline without time or language restrictions, and trial
registries maintained by the manufacturer. We included published and unpublished
randomized double-blinded, placebo-controlled trials of oseltamivir in adults
with suspected influenza that reported duration of symptoms, complications or
hospitalizations. We abstracted data regarding study quality, the duration of
symptoms and rates of complications and hospitalization.
RESULTS: Three published and eight unpublished studies met our inclusion
criteria. For the intention-to-treat (ITT) population, the mean reduction in the
duration of symptoms was 20.7 hours [95% confidence interval (CI) 13.3 to 28.0
hours]. Two large unpublished studies in the elderly and in adults with chronic
disease did not find a significant reduction in the symptom duration. There was
no difference in the likelihood of hospitalization in the ITT population (33/2633
patients for oseltamivir versus 20/1694 for placebo). The rate of complications
in the intention-to-treat infected (ITTI) population was reduced when acute
bronchitis was included (-2.8%, 95% CI -0.6 to -4.9), but not when it was
excluded. The risk of pneumonia was reduced in the ITTI population (-0.9%, 95% CI
-0.1 to -1.7) but not in the ITT population.
CONCLUSIONS: There is no evidence that oseltamivir reduces the likelihood of
hospitalization, pneumonia or the combined outcome of pneumonia, otitis media and
sinusitis in the ITT population.
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